Helping Iraq war's wounded a struggle

BY MARILYNN MARCHIONETHE ASSOCIATED PRESS

Sunday

Jun 24, 2007 at 12:50 AMJun 24, 2007 at 7:05 AM

More than 800 of them have lost an arm, a leg, fingers or toes. More than 100 are blind. Dozens need tubes and machines to keep them alive. Hundreds are disfigured by burns, and thousands have brain injuries and mangled minds.
These are America's war wounded, a toll that has received less attention than the 3,500 troops killed in Iraq. Depending on how you count them, they number between 35,000 and 53,000.
More of them are coming home, with injuries of a scope and magnitude the government did not predict and is struggling to treat.
"If we left Iraq tomorrow, we would have the legacy of all these people for many years to come," said Dr. Jeffrey Drazen, editor-in-chief of the New England Journal of Medicine and an adviser to the U.S. Department of Veterans Affairs. "The military simply wasn't prepared for its own success" at keeping severely wounded soldiers alive, he said.
Survival rates today are even higher than the record levels set early in the war, thanks to body armor and better care. For every American soldier or Marine killed in Iraq, 15 others have survived illness or injury there.
Unlike previous wars, few of them have been shot. The signature weapon of this war - the improvised explosive device, or IED - has left a signature wound: traumatic brain injury.
Soldiers hit in the head or knocked out by blasts - "getting your bell rung" is the military euphemism - sometimes have no visible wounds but a fog of war in their minds. They can be addled, irritable, depressed and unaware they are impaired.
Only an estimated 2,000 cases of brain injury have been treated, but doctors think many less obvious cases have gone undetected. One small study found that more than half of one group of wounded troops arriving at Walter Reed Army Medical Center had brain injuries. Around the nation, a new effort is under way to check every returning man and woman for this possibility.
Some of those on active duty may have subtle brain damage that was missed when they were treated for more visible wounds. Half of those wounded in action returned to duty within 72 hours - before some brain injuries may have been apparent. The military just adopted new procedures to spot these cases, too.
Back home, concerns grow about care. The Walter Reed hospital scandal and problems with some VA nursing homes have led Republicans and Democrats to call for better care for this new crop of veterans.
A lucky few get Cadillac care at one of the VA's four polytrauma centers, where the most complex wounds are treated with state-of-the-art techniques and whiz-bang devices. Others battle bureaucracy to see doctors or get basic benefits in less ideal settings.
Mental health problems loom large. More than a third of troops received psychological counseling shortly after returning from Iraq, and a third of those were diagnosed with a problem, a recent Pentagon study found. The government plans to add 200 psychologists and social workers to help treat post-traumatic stress disorder and other issues.
No one knows what the ultimate cost will be. Harvard University economist Linda Bilmes estimates the lifetime health-care tab for these troops will be $250 billion to $650 billion - a wide range but a huge sum no matter how you slice it.
THE WOUNDED
Lee Jones, 24, of Lumberton, N.C., was severely burned on the face, hands, feet and legs when his Humvee was hit with an IED two years ago. A partial amputee with speech and other problems from a severe brain injury, he now does work therapy delivering mail at a VA hospital and tries to re-establish life in a nearby apartment with a wife and baby daughter.
Marine Cpl. Joshua Pitcher, 22, from upstate New York returned to Iraq after he was shot in 2005. Half of his skull was removed to allow his brain to swell as he now recovers from a brain injury and shrapnel wounds from a grenade blast in February.
Maj. Thomas Deierlein, 39, is a New York City marketing executive who served five years after graduating from West Point. Twelve years later, called up as a reservist, he nearly died of bullet wounds that shattered his pelvis, leaving him with a colostomy and learning to walk again.
Joseph "Jay" Briseno, 24, of Manassas Park, Va., was shot in the back of the neck by an Iraqi in the early months of the war. One of the most severely wounded, he is now a quadriplegic, on a breathing machine, blind and unable to speak, but aware of what has happened to him.
"The mistake in Vietnam was, we hid the injured away from folks so they didn't get to tell their stories. Now it's important that we let them tell their stories to the public," said Dr. Steven Scott, director of the Polytrauma Rehabilitation Center at the Tampa VA Medical Center in Florida.
NEW TALLYING METHOD
Counting the wounded can be contentious. Earlier this year, the Department of Defense changed how it tallies war-related injuries and illness, dropping those not needing air transport to a military hospital from the bottom-line total.
Bilmes, the economist, thinks this is disingenuous.
"An accident that happens while they're there is a cost of war, particularly when you factor in the length of deployment" and injury-inducing conditions like very hot weather, carrying heavy packs, and more vehicle accidents because it is not safe to walk anywhere, she said.
As of June 2, 25,830 troops had been wounded in action. Of these, 7,675 needed airlifts to military hospitals and the rest were treated and remained in Iraq.
There were another 27,103 non-battle-related air transports. Of those, 7,188 had injuries. Most occurred from vehicle accidents, training or work-related accidents. Ten percent were sports injuries, said Dr. Michael Kilpatrick, who tracks this information for the Defense Department.

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